Expired CME Article
Pharmacologic Stress Myocardial Perfusion Imaging
Abstract
Abstract: Pharmacologic stress agents (dipyridamole, adenosine and dobutamine) allow virtually all patients to be safely assessed for ischemic heart disease. These agents have mild but significant side effects, mandating a thorough knowledge of indications, contraindications, side effects and management before their use. Adjunctive exercise improves image quality in vasodilator pharmacologic myocardial perfusion imaging. Diabetics, especially women, have a much higher cardiac event rate than nondiabetics for an equal amount of ischemia. They also have a higher incidence of asymptomatic ischemia. There is growing support for screening with myocardial perfusion imaging (MPI) for asymptomatic ischemia in diabetics. The ability of MPI to identify hypocontractile but viable myocardium, thus predicting improvement in myocardial function after revascularization, is one of the most powerful uses of the modality. Vasodilator MPI should be used as the initial test in patients with left bundle branch block or paced ventricular rhythm, even if they are able to exercise.
Key Points
* Despite its lower sensitivity, exercise ECG testing remains clinically useful in patients who can exercise adequately and have a normal baseline ECG.
* In patients who cannot exercise adequately, vasodilator MPI with any level of tolerable exercise or dobutamine echocardiography should be used for diagnosis and prognosis in patients with an intermediate pretest probability of CHD.
* Diabetics, especially women, have a much higher cardiac event rate than nondiabetics for an equal amount of ischemia. They also have a high incidence of asymptomatic ischemia. There is growing support for screening with myocardial SPECT for assessing asymptomatic ischemia in diabetics.
* The ability of SPECT imaging to identify hypocontractile but viable myocardium and thus predicting improvement in regional myocardial function after revascularization is one of the most powerful uses of the modality.
* Vasodilator MPI without exercise should be used as the initial test in patients with left bundle branch block or a paced ventricular rhythm, even in patients who are able to exercise.
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